Endometriosis is a condition in which tissue similar to your uterine lining grows outside of your uterine cavity. The endometrium is the lining of your uterus.
Endometriosis occurs when endometrial-like tissue develops on your ovaries, bowel, and pelvic tissues. Endometrial-like tissue rarely spreads beyond the pelvic region, but it is not impossible. An endometrial implant is endometrial-like tissue that grows outside of your uterus.
Your menstrual cycle’s hormonal fluctuations affect the displaced endometrial-like tissue, causing it to become irritated and uncomfortable. This indicates that the tissue will expand, thicken, and degrade. Over time, the degraded tissue has nowhere to go and becomes stuck in your pelvis.
This trapped tissue in your pelvis can lead to:
- irritation
- development of scars
- Adhesions are areas of tissue that connect your pelvic organs.
- extreme pain experienced during the menstrual cycle
- Fertility issues
Endometriosis signs and symptoms
Endometriosis symptoms differ. Some people have modest symptoms, while others have moderate to severe symptoms. The degree or stage of your condition is not indicated by the severity of your pain. You may have a modest type of the disease but be in excruciating agony. It is also possible to have a severe type while experiencing little discomfort.
It’s crucial to realize that you might not have any symptoms.
The most frequent symptom of endometriosis is pelvic pain. You can also experience the following symptoms:
- painful periods
- cramps for 1 or 2 weeks around menstruation
- Heavy menstrual hemorrhage or bouts of bleeding
- infertility
- discomfort during sexual intercourse
- bowel movement discomfort
- lower back ache that might come at any moment during your cycle
It is critical that you get regular gynecological exams so that your gynecologist can monitor any changes. This is especially critical if you have two or more symptoms.
Treatment for endometriosis
Understandably, you desire immediate relief from pain and other endometriosis symptoms. If left untreated, this ailment can interfere with your daily activities. Although there is no cure for endometriosis, its symptoms can be treated.
There are medical and surgical alternatives available to assist you manage your symptoms and any potential problems. Conservative treatments may be tried first by your doctor. If your problem does not improve, they may propose surgery.
Everyone’s reaction to various treatment alternatives varies. Your doctor will assist you in determining which one is best for you.
Among the treatment options are:
Medication for pain
You can try over-the-counter pain relievers like ibuprofen, but keep in mind that they aren’t always effective.
Hormone replacement treatment
Taking hormone replacement therapy can occasionally ease discomfort and slow the course of endometriosis. Hormone therapy assists your body in regulating the monthly hormonal changes that promote endometriosis tissue growth.
Contraception using hormones
Hormonal contraceptives reduce fertility by limiting monthly growth and endometrial-like tissue accumulation. In less severe endometriosis, birth control pills, patches, and vaginal rings can minimize or even eliminate pain.
The injection of medroxyprogesterone (Depo-Provera) is also successful in preventing menstruation. It halts the development of endometrial implants. It helps with pain and other symptoms. However, owing of the risk of weight gain, decreased bone production, and an increased incidence of depression in some situations, this may not be your first choice.
Agonists and antagonists of gonadotropin-releasing hormone (GnRH).
Gonadotropin-releasing hormone (GnRH) agonists and antagonists are used to prevent the generation of estrogen, which stimulates the ovaries. Lupron Depot, an injectable, is an example of a GnRH agonist, whereas Elagolix, an oral antagonist. Both have the ability to decrease estrogen production.
Estrogen is the hormone that is primarily responsible for the development of sexual traits in people who are born feminine. Menstruation is prevented and artificial menopause is created by inhibiting estrogen production.
GnRH treatment might cause vaginal dryness and hot flashes. Small amounts of estrogen and progesterone used concurrently can assist to lessen or prevent these symptoms.
It can be difficult to obtain a diagnosis and begin treatment options early in the condition. Thinking about — or dealing with — symptoms such as infertility and discomfort, as well as the possibility of relief, can be stressful.
Addressing your mental wellness as part of your total well-being is critical. Consider joining a support group and learning more about the disease. Taking these measures can aid in the development of a well-balanced strategy to managing your disease.
Danazol
Danazol is another medicine used to stop menstruation and alleviate endometriosis symptoms. Danazol may cause the condition to worsen while being taken. Danazol might induce acne and hirsutism as adverse effects. Hirsutism is characterized by excessive hair growth on the face and body.
Other medications that may relieve symptoms and reduce disease development are being researched.
Surgery that is conservative
Conservative surgery is often performed for patients who wish to become pregnant or who are in significant discomfort and find that hormonal therapies are ineffective. Conservative surgery aims to remove or eradicate endometrial growths without causing harm to the reproductive organs.
Endometriosis is visualized and diagnosed through laparoscopy, a minimally invasive technique. It is also utilized to remove misplaced or aberrant endometrial-like tissue. A surgeon makes small incisions in the belly to surgically remove or burn or vaporize the growths.
Lasers are now widely utilized to eliminate “abnormal” tissue.
Last-ditch surgery (hysterectomy)
If alternative therapies fail to improve your health, your doctor may consider a total hysterectomy as a final resort.
A total hysterectomy involves the removal of the uterus and cervix by a surgeon. They also remove the ovaries since these organs produce estrogen, which can cause endometrial-like tissue to form. The surgeon also eliminates obvious implant lesions.
Depending on the problem being treated, two distinct types of hysterectomies are performed.
A subtotal hysterectomy, also known as a partial or supracervical hysterectomy, removes the upper section of the uterus while leaving the cervix in situ.
When malignancy is present, a radical hysterectomy is usually performed. The whole uterus, cervix, and top section of the vagina are removed.
Endometriosis can be treated with a hysterectomy, but it is not a cure. After a hysterectomy, you will be unable to conceive. Get a second medical opinion before agreeing to surgery if you’re thinking about starting a family.
What causes endometriosis?
During a normal menstrual cycle, your body eliminates the uterine lining. This allows menstrual blood to travel from the uterus through the cervix and out through the vagina.
The precise cause of endometriosis is unknown. There are various theories on the cause, but none of them has been scientifically proven.
One of the oldest ideas holds that endometriosis is caused by a phenomenon known as retrograde menstruation, which 90 percent of women experience, according to study. This occurs when menstrual blood flows back into your pelvic cavity through your fallopian tubes rather of exiting your body through the vagina.
Another explanation is that hormones change the cells outside the uterus into endometrial cells, which are comparable to the cells lining the inside of the uterus.
Others believe the illness develops when little portions of your abdomen transform into endometrial-like tissue. This is possible because cells in your abdomen develop from embryonic cells, which can alter shape and function similarly to endometrial cells. It is unknown why this happens.
These displaced endometrial cells may reside on the surfaces of your pelvic organs, such as your bladder, ovaries, and rectum. In response to the hormones of your cycle, they continue to develop, thicken, and leak throughout your menstrual cycle.
Menstrual blood can also leak into the pelvic cavity through a surgical scar, such as after a cesarean delivery, also known as a C-section.
Another hypothesis is that endometrial cells are carried out of the uterus via the lymphatic system. Another idea proposes that it is related to the immune system failing to remove faulty endometrial cells.
Some believe endometriosis originates in the embryonic stage with misdirected cell tissue that responds to puberty hormones. This is known as Mullerian theory.
Endometriosis may also be caused by genetic factors or by environmental pollutants.
Stages of endometriosis
Endometriosis is classified into four stages or kinds. It might be any of the following options:
- minimal
- mild
- moderate
- severe
The stage of the illness is determined by a variety of circumstances. Endometrial implants’ placement, number, size, and depth are examples of such characteristics.
Stage 1: Minimal
On your ovaries, you may have tiny lesions or sores, as well as superficial endometrial implants, if you have minor endometriosis. Inflammation in or around your pelvic cavity is also possible.
Stage 2: Mild
Mild endometriosis is characterized by small lesions and superficial implants on the ovaries and pelvic lining.
Stage 3: Moderate
Moderate endometriosis is characterized by several deep implants on your ovaries and pelvic walls. There may potentially be other lesions.
Stage 4: Severe
Endometriosis at its most severe level comprises several deep implants on your vaginal lining and ovaries. Your fallopian tubes and bowels may also have lesions. There could also be cysts on one or both of your ovaries.
Diagnosis of Endometriosis
Endometriosis symptoms might be similar to those of other illnesses such as ovarian cysts and pelvic inflammatory disease. The illness also has symptoms that are comparable to irritable bowel syndrome (IBS), which might delay diagnosis.
Getting an appropriate diagnosis is crucial to treating your pain. It is vital to remember that the diagnosing procedure may differ from one another. According to 2019 research, it can take 4 to 11 years from the onset of symptoms to diagnosis in some cases.
As you work with your healthcare team, try to be patient with yourself and the process.
One or more of the following tests will be performed by your doctor:
Detailed history
Your symptoms, as well as any personal or family history of endometriosis, will be noted by your doctor. A general health examination may also be carried out to see whether there are any additional indicators of a long-term condition.
Physical examination
Your doctor will use a speculum and light to examine the vagina and cervix during a pelvic exam. In addition, they will personally feel your abdomen for cysts or scars behind the uterus.
Ultrasound
A transvaginal ultrasound or an abdominal ultrasound may be used by your doctor. A probe is put into your vagina during a transvaginal ultrasound.
Both ultrasound methods produce images of your reproductive organs. They can assist your doctor in identifying cysts associated with endometriosis, but they cannot rule out the disease.
Laparoscopy
The only sure way to recognize endometriosis is to look at it firsthand. This is accomplished by a simple surgical procedure known as laparoscopy. The tissue can be removed in the same treatment if it has been diagnosed.
Complications of endometriosis
Fertility problems are a serious complication of endometriosis. Individuals with milder versions of the disease may be able to conceive and carry a child to term.
Although drugs are available to treat endometriosis, they do not improve fertility.
After having endometrial-like tissue surgically removed, some women have been able to conceive. If this does not work for you, you might want to think about fertility treatments or in vitro fertilization to increase your chances of having a baby.
Discuss your options with your doctor, such as if you want to create a family and whether you should consider having children sooner rather than later if you have endometriosis. Alternatively, your doctor can assist you in learning more about other options for becoming a parent or delaying pregnancy.
Endometriosis symptoms might grow with time, making it harder to conceive naturally. Your doctor will need to do an examination both before and during your pregnancy.
Even if fertility is not an issue for you, managing chronic discomfort can be difficult. Depression, anxiety, and other mental health difficulties are not commonplace in endometriosis patients.
Discuss with your doctor how you can cope with these side effects. They may advise you to join a support group or use other helpful tools to assist you manage your problem.
Risk factors about Endometriosis
Endometriosis normally appears years after your menstrual cycle begins. It’s a painful condition.
Understanding its risk factors, on the other hand, might help you identify whether you’re more prone to acquire this ailment and when you should consult your doctor.
Age
Endometriosis can affect women of any age. It primarily affects women in their 30s and 40s, but symptoms can appear as early as puberty.
Ancestral history
If you have a family member who has endometriosis, consult your doctor. You may be at a higher risk of contracting the condition.
History of Pregnancy
Pregnancy can temporarily alleviate endometriosis symptoms. Women who have never had children are more likely to acquire the disease. Endometriosis can, however, still occur in women who have had children. This adds to the notion that hormones play a role in the genesis and progression of the illness.
History of menstruation
If you’re having trouble with your menstruation, consult your doctor. These problems may include:
- shorter cycle times
- longer and heavier periods
- Menstruation begins at a young age
These variables may put you at greater risk.
Data on race and ethnicity research
While endometriosis affects approximately 11% of American women aged 15 to 44, according to the US Department of Health and Human Services, a 2019 study discovered that race and ethnicity may influence its occurrence.
Hispanic and Black women are less likely than white women to be diagnosed with endometriosis. In contrast, Asian women were 50% more likely than white women to receive a diagnosis.
A 2019 assessment indicated that when data were restricted to women with infertility, inequities for Black women were minimized; there was no statistical significance between Black, white, and Asian patients. According to the researchers, it is unknown whether past links were made due to diagnostic biases or other reasons.
Furthermore, there is a scarcity of studies examining the prevalence and effects in American Indian or Alaskan Native women.
Overall, more comprehensive study that takes into account environmental and socioeconomic factors, as well as access to healthcare, is required to better understand the condition.
Summery
Endometriosis is an idiopathic chronic disorder, which means that no one knows what causes it. And there is no remedy at the moment.
However, there are effective therapies available, such as drugs, hormone therapy, and surgery, to help control its negative effects and problems, such as discomfort and reproductive concerns. Endometriosis symptoms usually improve after menopause.
If you suspect you have endometriosis, you should call your doctor right away to begin the process of acquiring an accurate diagnosis and eventually developing a plan based on your individual case.
